To make it easy for you to keep up to date with developments, IAC has
gathered important information related to H1N1 influenza into a single web
section. To access this resource, go to: http://www.immunize.org/h1n1

Leading physician groups urge pregnant women to get both seasonal and 2009
H1N1 influenza vaccines

The American Medical Association recently posted
a press
release on its website announcing that it, two other
physician groups, and CDC have jointly developed a Dear
Colleague letter about the importance of vaccinating
pregnant women with both seasonal and 2009 H1N1 influenza
vaccines. The first two paragraphs of the press release are
reprinted below.

At the end of this IAC Express story you will find links to
the Dear Colleague letter, to a patient information sheet
titled Pregnant Women and the Flu (available in English and
Spanish), and to a CDC document titled 2009 H1N1 Influenza
Vaccine and Pregnant Women: Information for Healthcare
Providers.

To help stress the urgent message that pregnant women must
get vaccinated against both seasonal influenza and 2009 H1N1
to protect themselves and their unborn baby, the American
Medical Association (AMA), American Academy of Family
Physicians (AAFP), American College of Obstetricians and
Gynecologists (ACOG), and the Centers for Disease Control
and Prevention (CDC) joined forces today. In a group letter
sent to healthcare professionals nationwide, leaders from
the four groups emphasized the increased number of deaths
among pregnant women from influenza and provided helpful
information for medical professionals.

The letter urges health care professionals to encourage
their pregnant patients to get vaccinated and counsel them
on the benefits of the vaccine. Both the seasonal influenza
vaccine and the H1N1 vaccine are safe to administer to
pregnant women in any trimester and can be given
simultaneously. Pregnant women should be given the flu shot,
not the nasal spray version of the vaccine. . . .

MMWR publishes article on fatal case of human rabies in Missouri in 2008

CDC published "Human Rabies--Missouri, 2008" in
the November
6 issue of MMWR. Portions of the article are reprinted
below.

On November 24, 2008, the Missouri State Public Health
Laboratory notified CDC of suspected rabies in a man aged 55
years from Missouri. The man had been bitten by a bat
4-6 weeks before symptom onset and had not sought medical
care at the time of the bite. After visiting two emergency
departments (EDs) with symptoms consistent with rabies, he
was hospitalized on November 23 and treated using the
Milwaukee protocol. On November 26, infection with a rabies
virus variant associated with silver-haired bats was
confirmed. The patient died on November 30. This report
summarizes the patient's treatment and clinical course. The
report highlights the importance of raising public awareness
of rabies, particularly the risk for rabies after bat and
other wildlife exposures. Healthcare providers should
maintain a high clinical suspicion for rabies in patients
with a recent animal bite history and unexplained
encephalitis. . . .

Editorial Note:
The death described in this report illustrates the
importance of promptly seeking medical evaluation after any
potential bat exposure (i.e., any direct contact between a
human and a bat) regardless of the health of the bat. Rabies
is preventable if rabies immune globulin and vaccine are
administered soon after an exposure. Bat exposures are of
special concern because of the higher risk associated with
bat exposures and because the wounds they inflict often are
minor and easily overlooked. For bat contacts, even finding
a bat in the same room might qualify as a potential exposure
if the person might be unaware that a bite or direct contact
had occurred (e.g., a deeply sleeping person awakens to find
a bat in the room, an adult sees a bat in the room with a
previously unattended child, mentally disabled person, or
intoxicated person), although such situations should not be
considered exposures if rabies can be ruled out by
diagnostic testing of the bat, or circumstances suggest it
is unlikely that an exposure took place.

Once symptoms begin, rabies has no standard treatment and is
nearly always fatal. The Milwaukee protocol is an
experimental treatment for rabies that was first used in
2004 as therapy in a Wisconsin patient who recovered from
the disease. Subsequent attempts to treat rabies patients
have been unsuccessful in North America; however, initial
recovery was noted in one patient in Equatorial Guinea,
whose subsequent death was attributed to malnutrition rather
than rabies. . . .

Public education remains an important part of rabies
prevention. Persons who are unvaccinated against rabies or
lack appropriate training should be warned against handling
bats. Campaigns aimed at elevating rabies awareness also
should address misconceptions and attitudes that can lead to
a lack of timely responsiveness to rabies virus exposures.

On November 2, the Department of Health and Human
Services
(HHS) issued a press release titled "Initial Results Show
Pregnant Women Mount Strong Immune Response to One Dose of
2009 H1N1 Flu Vaccine." A portion of the press release is
reprinted below.

Healthy pregnant women mount a robust immune response
following just one dose of 2009 H1N1 influenza vaccine,
according to initial results from an ongoing clinical trial
sponsored by the National Institute of Allergy and
Infectious Diseases (NIAID) of the National Institutes of
Health.

"For pregnant women, who are among the most vulnerable to
serious health problems from 2009 H1N1 infection, these
initial results are very reassuring," says NIAID Director
Anthony S. Fauci, MD. "The immune responses seen in these
healthy pregnant women are comparable to those seen in
healthy adults at the same time point after a single
vaccination, and the vaccine has been well tolerated."

According to the Centers for Disease Control and Prevention,
since the outbreak began last spring, at least 100 pregnant
women have been hospitalized in intensive care units in the
United States and at the last official count, 28 pregnant
women have died. . . .

On November 5, the U.S. Department of Health and
Human
Services released a statement to the press regarding
contract awards for antiviral drugs to help treat
hospitalized 2009 H1N1 influenza patients. The first three
paragraphs of the press release follow.

The U.S. Department of Health and Human Services (HHS) today
announced contract awards for up to 120,000 treatment
courses of intravenous (IV) antiviral drugs to help treat
hospitalized 2009 H1N1 influenza patients.

Patients hospitalized with 2009 H1N1 influenza are evaluated
to determine if antiviral drugs will be useful; some
patients are not able to take the drugs that are currently
available as pills or liquid and may benefit from
intravenous antiviral medications.

To help meet the potential need for IV medications to combat
the H1N1 virus, HHS ordered 10,000 treatment courses each
from BioCryst, Roche, and GlaxoSmithKline, totaling $31.5
million. The contracts allow HHS to place additional orders
of up to 30,000 treatment courses with each manufacturer
over two years. Roche manufactures Tamiflu; GlaxoSmithKline,
Relenza; and BioCryst manufactures Peramivir. . . .

On November 6, CDC's Health Alert Network issued
an Info
Service Message containing key issues for clinicians
concerning antiviral treatments for 2009 H1N1 influenza. The
message advises clinicians that currently not all people
recommended for antiviral treatment are being treated. It
outlines recommendations for clinicians in making the
judgment to treat and presents links to a variety of
relevant CDC and FDA documents.

AAP offers information on coding for influenza vaccine and its administration

Pages 6-10 of the November issue of the AAP
Immunization
Initiatives Newsletter are devoted to an article titled
"Coding for the Product & Administration of Influenza
Vaccine." In addition, two other influenza coding documents
are available on the AAP website; links to those are given
below.

IAC's Video of the Week--"Sneezing 101"--shows how a simple hygiene step can
keep you and others healthy

"Sneeze in your sleeve" is the message of this
entertaining
2-minute video developed by the Virginia Department of
Health. As a team of school-age "researchers" demonstrate,
proper sneezing technique can reduce the spread of influenza
virus infection.

The video will be available on the home page of IAC's
website through November 15. To access it, go to:
http://www.immunize.org and click on the image under the
words Video of the Week. It may take a few moments for the
video to begin playing; please be patient!

Remember to bookmark IAC's home page to view a new video
every Monday. To view an IAC Video of the Week from the
past, go to the video archive at http://www.immunize.org/votw

(5) "Pneumonia Can Be Prevented--Vaccines Can Help" teaches
that although pneumonia, on a global scale, causes more
deaths than any other infectious disease, it can often be
prevented with vaccines and can usually be treated with
antibiotics or antiviral drugs.

If you're wondering if you should continue to
vaccinate
patients against seasonal influenza now that H1N1 influenza
vaccine has become available, the answer is YES! The 2009
H1N1 influenza vaccine will not protect people against
seasonal influenza, and seasonal influenza vaccine will not
protect against H1N1 influenza.

Immunization Techniques video (DVD or VHS) offers a great way to give staff
high-quality vaccination training

If your healthcare setting is vaccinating a lot
more people
than usual because of H1N1 influenza, this is a great time
for your staff to review the recommended immunization
techniques shown in the video Immunization Techniques: Safe,
Effective, Caring. This popular and highly lauded 35-minute
video offers healthcare providers a way to train their
staff--quickly, effectively, and affordably (only $10.50 for
each DVD or VHS ordered).

Developed in 2001 by the California Department of Health
Services Immunization Branch in collaboration with a team of
national experts, the video teaches best practices for
administering intramuscular (IM) and subcutaneous (SC)
vaccines to infants, children, and adults. PLEASE NOTE
however, that because the video was released in 2001, it
does NOT provide instruction on administering the nasal-spray influenza vaccines or the oral rotavirus vaccines.
These vaccines were licensed after 2001.

Available in DVD and VHS formats, the video is designed for
use as a "hands-on" instructional program for new staff, as
well as a refresher course for experienced healthcare
professionals. It discusses the following:

Anatomic sites

Choice of needle size

Vaccines and routes of administration

Demonstrations of infants, toddlers, kindergartners, and
adults being vaccinated

How to "draw up" doses of vaccine

PRICING, ORDERING, AND ADDITIONAL INFORMATION. The cost is
$10.50 per copy of the DVD or VHS.

October issue of CDC's Immunization Works electronic newsletter recently
released

CDC recently released the October issue of its
monthly
newsletter Immunization Works; it is posted on the website
of the National Center for Immunization and Respiratory
Diseases (NCIRD). The newsletter offers the immunization
community information about current topics. The information
is in the public domain and can be reproduced and circulated
widely.

Most of the information in the October issue has already
appeared in previous issues of IAC Express. Here are the
titles of articles in the October issue:

CDC Publishes VISs for Influenza Vaccines

Update on Influenza A (H1N1) 2009 Monovalent Vaccines

Standing Orders for Administering Influenza A (H1N1) 2009
Monovalent Vaccines Now Available

Correction: IAC Express amends statistic on annual number of meningitis cases
reported among U.S. infants

In IAC Express #830, dated November 2, 2009, IAC
made an
error of fact in the article titled "November 17 webcast and
teleconference on the impact of infant meningococcal disease
to feature renowned experts"
(http://www.immunize.org/express/issue830.asp#n11).

The article stated that CDC estimates that infant
meningococcal disease affects 1,000-3,000 U.S. infants each
year. The accurate information is that CDC estimates that
each year there are approximately 400 cases of meningococcal
disease among U.S. children younger than age 5 years and
approximately 1,000-3,000 cases among people of all ages.
IAC regrets the error and any inconvenience it may have
caused readers of IAC Express.

Notice: November 17 teleconference on infant meningococcal diseases has been
postponed

The organizers of the IMD [Infant Meningococcal
Disease]
Aware Coalition's November 17 teleconference on infant
meningococcal disease have informed us that the
teleconference has been postponed. The teleconference was
announced in the November 2 issue of IAC Express. We will
notify readers once we learn the date of the rescheduled
teleconference.

With vaccination against 2009 H1N1 influenza
underway, it is
important to remember that seasonal influenza vaccination
efforts must continue. To aid in these efforts, the
Immunization Action Coalition is inviting IAC Express
readers to place orders now for the National Influenza
Vaccine Summit's 2009-10 Seasonal Influenza Vaccination
Pocket Information Guides. They're free!

These laminated, 3.75 x 6.75-inch, 2-color cards serve as a
convenient reference for front-line healthcare professionals
who vaccinate patients. The cards provide the following
information:

Indications, contraindications, and precautions for the
injectable and intranasal seasonal influenza vaccines

Populations targeted for seasonal influenza vaccination

Dosage and route of administration for all the various
seasonal influenza vaccine products

Each of these pocket guides is designed to be used by
healthcare professionals only; THEY ARE NOT PATIENT
HANDOUTS.

HOW TO ORDER
Each order must be for a minimum of 100 pocket guides. Place
your order at http://www.preventinfluenza.org/pocketguides
There is no cost for the pocket guides, shipping, or
handling within the U.S. Quantities are limited, so to avoid
disappointment, place your order today!

BACKGROUND
These pocket guides were developed by, and are being
provided under the sponsorship of the National Influenza
Vaccine Summit, http://www.preventinfluenza.org The Summit
brings together public and private stakeholders to
facilitate and promote influenza vaccination. The pocket
guides are also distributed by many major medical, nursing,
and pharmacist organizations, specialty societies, state
health departments, Indian Health Service Area facilities,
Quality Improvement Organizations, Visiting Nurse
Associations, community vaccinators, and many others.

Thanks for your dedication to immunization, and don't forget
to keep vaccinating against seasonal influenza through the
spring months!

Dated 10/2/09, the VISs for 2009 H1N1 inactivated
influenza
vaccine (injectable) and 2009 H1N1 live attenuated influenza
vaccine (nasal spray) are now available in Amharic (spoken
in Ethiopia), Armenian, Bulgarian, Burmese, Cambodian, Oromo
(spoken in Ethiopia and Kenya), Polish, Portuguese, Samoan,
Serbo-Croatian, Ukrainian, and Vietnamese. IAC gratefully
acknowledges the Massachusetts Department of Public Health
for the Portuguese translations; the California Department
of Public Health, Immunization Branch, for the Armenian,
Cambodian, Bulgarian, Burmese, Polish, Samoan, Serbo-Croatian, Ukrainian, and Vietnamese translations; and the
Minnesota Department of Health for the Amharic and Oromo
translations.

VISs FOR THE INJECTABLE 2009 H1N1 INFLUENZA VACCINE

To access the new translations (Amharic, Armenian,
Bulgarian, Burmese, Cambodian, Oromo, Polish, Portuguese,
Samoan, Serbo-Croatian, Ukrainian, and Vietnamese), of the
VIS for the injectable 2009 H1N1 influenza vaccine, as well
as this VIS in English and other translations, go to: http://www.immunize.org/vis/vis_h1n1_inactive.asp Click on
the pertinent languages.

VISs FOR THE NASAL-SPRAY 2009 H1N1 INFLUENZA VACCINE

To access the new translations (Amharic, Armenian,
Bulgarian, Burmese, Cambodian, Oromo, Polish, Portuguese,
Samoan, Serbo-Croatian, Ukrainian, and Vietnamese) of the
VIS for the nasal-spray 2009 H1N1 influenza vaccine, as well
as this VIS in English and other translations, go to: http://www.immunize.org/vis/vis_h1n1_live.asp Click on the
pertinent languages.

For information about the use of VISs, and for VISs in more
than 35 languages, visit IAC's VIS web section at http://www.immunize.org/vis

The current version of the VIS for pneumococcal
polysaccharide vaccine (PPSV), dated 10/6/09, is now
available on the IAC website in Turkish. IAC gratefully
acknowledges Mustafa Kozanoglu, MD, and Murat Serbest, MD,
for the translation.

The November issue of AAP's journal Pediatrics
includes an
article titled "Recommendations for Screening, Monitoring,
and Referral of Pediatric Chronic Hepatitis B." The abstract
is reprinted blow.

Most children with chronic hepatitis B virus infection
(persistent hepatitis B surface antigen-positive for >6
months) are asymptomatic and do not generally require
treatment. These children are, however, at increased risk
for severe complications later in life, including advanced
liver disease and liver cancer. On November 11, 2008, the
Hepatitis B Foundation, a nonprofit research and disease
advocacy organization, convened a panel of nationally
recognized North American pediatric liver specialists to
consider and recommend an approach for the screening,
monitoring, initial management, and referral of children
with chronic hepatitis B. The panel developed
recommendations to provide guidance to practitioners on
determining what additional tests to conduct, how often to
monitor on the basis of test results, and when to refer to a
pediatric liver specialist to build a partnership between
the practitioner and liver specialist to enhance the success
of management of children with this lifelong infection.

CDC published "Human Vaccinia Infection After
Contact with a
Raccoon Rabies Vaccine Bait--Pennsylvania, 2009" in the
November 6 issue of MMWR. A summary made available to the
press is reprinted below in its entirety.

Dog owners should not attempt to remove baits from a dog's
mouth. Gloves or plastic bags should be used to pick up and
examine baits if necessary and additional baits that might
be picked up by dogs or other pets should be removed from
the immediate area. Individuals who are concerned that they
might have been exposed to oral rabies vaccine from a
ruptured bait should call the phone number written on the
bait or call their local health department.

Vaccination of raccoons (and other wildlife) for rabies is
accomplished in the United States using a live, oral
vaccine. The vaccine is distributed in baits, which are
ingested by raccoons. Vaccinia virus is the live component
in the oral rabies vaccine. In August 2009, shortly after
initiation of the autumn baiting campaign in western
Pennsylvania, a woman developed multiple vaccinia virus
lesions on her hand approximately five days after coming
into contact with the oral rabies vaccine. Liquid vaccine
had dripped onto her skin from a punctured bait that she had
retrieved from her dog. The woman, who had been taking
immune suppressive medications to treat inflammatory bowel
disorder, was treated with vaccinia immunoglobulin and an
investigational anti-viral agent.

Updated in 2009, "Be Wise--Immunize: Physician
Toolkit for
Adolescents" is a comprehensive reference guide on
adolescent vaccinations for physicians and their staff.
Published by the Texas Medical Association and Texas Medical
Association Alliance, the toolkit contains a few resources
pertinent only to Texas (e.g., Texas vaccination
requirements, Texas Vaccines for Children program). Most of
the materials have universal application, however.

For comprehensive conference information, including
information on the conference program, go to:
http://www.ilmaternal.org/ncihc2010.html Click on the links
in the dark purple box located in the lower right corner of
the web page.

This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.